Mental health and work in Denmark 2013

MENTAL HEALTH AND WORK: DENMARK

OECD conclusions and recommendations

Christopher PRINZDirectorate for Employment, Labour and Social AffairsOECD

www.oecd.org/els/disability >Denmark

Dissemination Seminar- 25/02/2013 - Copenhagen

http://www.oecd.org/els/disability

MAKING LABOUR MARKET REFORMS A SUCCESSThe challenge: Previous reforms have failed

The number of people on health-related benefits has changed very little in the past few yearsRecipients of different working-age benefits in Denmark, 2004-2011

Source: OECD (2013), Mental Health and Work: Denmark, Paris: OECD Publishing.

0

50

100

150

200

250

300

2004 2005 2006 2007 2008 2009 2010 2011

Unemployment benefit Social assistance Rehab & pre-rehab

Sickness benefit Flexjob & waiting allowance Disability benefit

MAKING LABOUR MARKET REFORMS A SUCCESS Possible ways forward

• Reasons for the failure of previous reforms (of the disability benefit system and the flexjob scheme)

• Why success of reforms for people with a mental illness is critical for the success of the reforms more generally

• Policy recommendations

– Flexjob reform: rigorous implementation to do away with the many weaknesses of the system; ensure that the “right” group of people access the system (significant but not permanent work incapacity).

– Disability reform: clear roles and adequate incentives for the key actors to ensure that the rehab model can deliver; evaluation of the factors responsible for success and/or failure of the reform.

– Reform of reimbursement of municipal spending: monitor and evaluate the impact on different client groups of any changed but also simplified funding mechanism.

SCHOOL SUPPORTS & SCHOOL DROP-OUTThe challenge: School drop-out remains high

Early school-leaving is frequent in Denmark partly because of high drop-out from vocational education

Proportion of youth aged 20-24 (i) not in education and without upper-secondary diploma (early school leavers) and (ii) not employed and not in education (NEET), 2009


0

5

10

15

20

25

30

Early school-leaving rate NEET rate

SCHOOL SUPPORTS & SCHOOL DROP-OUT Possible ways forward

• Youth Guidance Centres – a good-practice model with enormous potential

• Possible explanations for the high rate of drop-out from vocational schools: limited evidence


– Schools and teachers need sufficient resources and competencies to deal with common mental disorders, and work together with better resourced municipal educational-psychological advisory services.

– Youth Guidance Centres could be more effective with better ways and more resources to identify and help young people with mental disorders, and they should also be responsible for those aged 25-29.

– School drop-outs with a mental disorder need help quickly to be able to access the labour market (including demand and supply measures; mandatory enrolment in an education programme).

MENTAL HEALTH RISKS IN THE WORKPLACEThe challenge: Mental health impacts productivity

Performance problems at work seem massive also for those with a common mental disorderShare of workers not absent in the past four weeks who accomplished less than they would

have liked as a result of an emotional or a physical health problem, 2005 and 2010


0

10

20

30

40

50

60

70

80

90

100

Severe disorder

Moderate disorder

No mental disorder

Severe disorder

Moderate disorder

No mental disorder

Denmark EU-21

2005 2010

MENTAL HEALTH RISKS IN THE WORKPLACE Possible ways forward

• Promising attempts to address the psychosocial working environment (PWE)

• How forceful and effective are measures and agreements of the social partners?


– Increase resources for PWE risk assessment and inspections and monitor employer actions and responsibilities on preventing PWE risks; with special support to small and medium-sized enterprises.

– Work environment consultants could play a role as independent workplace conflict managers and work accommodation facilitators; to promote job retention and prevent sickness absences.

– Monitor and support employers’ sickness absence management actions, involve job centres and doctors as early as necessary (not only after 8 weeks); and promote a gradual return to work.

HELPING CLIENTS OF MUNICIPAL JOB CENTRESThe challenge: Many clients have a mental illness

The majority of recipients of social assistance and long-term sickness benefits have a mental disorder Proportion of beneficiaries with severe or moderate mental disorder, by type of

benefit, 2005


0

10

20

30

40

50

60

Long-termsickness

Disabilitybenef it

Unemploymentbenef it

Socialassistance

Severe mental disorder Moderate mental disorder

HELPING CLIENTS OF MUNICIPAL JOB CENTRES Possible ways forward

• Open access to employment services for everyone is not good enough to reach people with a mental disorder

• The match-group approach used by job centres (with three broad match groups) can be refined


– Develop better instruments to identify clients’ mental illness and the resulting mental health-related labour market barriers.

– Make clients with a mental disorder a new target group for job centres (regional/national targets) and intervene earlier for them.

– Pay particular attention to clients moving from unemployment onto sickness benefit, and those on social assistance and at risk of moving onto a permanent disability benefit..

– Invest resources in (i) lowering caseloads for clients with a mental disorder and (ii) psychological training for caseworkers.

FEATURES OF THE DISABILITY BENEFIT SYSTEMThe challenge: A system not designed for new issues

Most disability benefit claimants with a mental disorder were out of work for a very long time Share employed in the five years prior to a disability benefit claim, by health condition, 2009


0

10

20

30

40

50

60

70

80

Neoplasms Circulatory Injury,poisoning

Nervous,eye, ear

Musculo-skeletal

Respiratory Mentaldisorder

Congenital,chromosomal

FEATURES OF THE DISABILITY BENEFIT SYSTEM Possible ways forward

• Work capacity assessment through the resource profile is ineffective, especially for those with a mental illness

• Claimants with a mental illness are different but there work capacity is highly underestimated


– Use the experiences from the return-to-work trial for improving the rather ineffective resource profile, also to achieve swifter decisions agreed by different systems (e.g. health system and benefit system).

– Extend the planned rehabilitation model with integrated employment, social and health service to all age groups (provided it is effective).

– Rigorously and systematically reassess disability benefit entitlements, including of long-term clients who rarely seek voluntary supports.

– Evaluate the impact of the high level of disability benefit payments especially for low-wage earners.

STATE-OF-THE-ART MENTAL HEALTH CAREThe challenge: Lack of adequate treatment

Moderate mental disorders are rarely treated and if so only by non-specialistsShare of people who sought treatment for their mental illness in the past three months,

by severity of the mental disorder and type of treatment, 2005


Panel A. Severe mental disorders Panel B. Moderate mental disorders

0 10 20 30 40 50 60

Denmark

OECD-21

0 10 20 30 40 50 60

Denmark

OECD-21

Specialist treatment Non-specialist treatment

STATE-OF-THE-ART MENTAL HEALTH CARE Possible ways forward

• Does mental health care supply match the demand? How many (more) people need treatment?

• A poor link between health and employment services: from cooperation to integration of services


– Increase mental health care capacity at all levels (psychiatrists; specialist nurses; authorised psychologists) to reduce waiting times.

– Further improve mental health knowledge of general practitioners and facilitate systematic mental health screening in their practices.

– Promote shared-care models to facilitate a better connection between primary and specialist mental health care.

– Develop effective ways of integrated health and employment services (in both the health and the labour field).

CONCLUSIONS

• Mental ill-health creates considerable labour market disadvantage and generates high costs for the economy

• The Danish system is in a good position in principle to tackle mental health issues forcefully

• But the strong setup does not deliver because structures are under-resourced and the relevant actors lack the means to identify mental disorders

• A number of steps can be taken to improve outcomes

– … related to ongoing labour market reforms that need to deliver

– … related to various individual tools, structures and services

– …related to the integration of health and employment services

Thank you for your attention!

For more information and OECD publications on the topic:

www.oecd.org/els/disability

Including free access to the Executive Summary and all tables and charts of “Mental Health and Work: Denmark”

http://www.oecd.org/els/disability

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Mental health and work in Denmark 2013